恶性肿瘤患儿完全植入式静脉输液港手术并发症

doi:10.19723/j.issn.1671-167X.2022.06.018

摘要/Abstract

摘要：

目的: 总结完全植入式静脉输液港(totally implantable venous access port，TIVAP)在恶性肿瘤患儿中应用的手术经验，探讨其手术并发症的应对方法。方法: 回顾性分析北京大学第一医院小儿外科2017年1月至2019年12月期间165例接受TIVAP植入术的恶性肿瘤患儿病例资料，记录并统计TIVAP植入的手术过程、并发症及并发症处理情况。结果: 本组患儿按手术方式不同分为颈外静脉切开组(n=27)和颈内静脉穿刺组(n=138)，后者又分为超声引导穿刺组(n=95)和盲穿刺组(n=43)。颈外静脉切开组无穿刺并发症发生，其平均置管成功所用时间和导管进入上腔静脉所用顺管次数均多于颈内静脉穿刺组[(9.26±1.85) min vs. (5.76±1.56) min，(1.93±0.87)次vs. 1次]，差异有统计学意义。超声引导颈内静脉穿刺组平均置管成功所用时间、一次穿刺成功率、平均穿刺次数和穿刺并发症发生率均优于盲穿刺组[(5.36±1.12) min vs. (6.67±1.99) min，93.68%(89/95) vs. 74.42%(32/43)，(1.06±0.24)次vs. (1.29±0.55)次，2.11%(2/95) vs. 11.63%(5/43)]，差异有统计学意义。本组总并发症发生率12.12%(20/165)，其中气胸1例，误穿动脉1例，局部血肿5例，输液港相关性感染4例(输液港局部感染2例、导管相关性血流感染2例)，港座表面皮下组织变菲薄2例，港座翻转1例，输液不畅4例(导管弯折1例、导管堵塞3例)，皮下管路周围排异物聚集2例，未发生导管断裂、脱落和导管夹闭综合征等并发症。结论: TIVAP能为恶性肿瘤患儿提供安全有效的输液通道，颈外静脉切开和超声引导颈内静脉穿刺是小儿TIVAP植入的可靠术式。手术医师应对TIVAP并发症有充分的认识，采取措施减少并发症的发生，正确处置已发生的并发症。

关键词: 完全植入式静脉输液港, 导管插入术, 手术后并发症, 儿童

Abstract:

Objective: To summarize the surgical experience of totally implantable venous access port in children with malignant tumors, and to explore the coping methods of surgical complications. Methods: The clinical data of 165 children with malignant tumors implanted in totally implantable venous access port in Department of Pediatric Surgery, Peking University First Hospital from January 2017 to December 2019 were retrospectively analyzed. The operation process, complications and treatment of complications were observed and counted. Results: The children in this group were divided into external ju-gular vein incision group (n=27) and internal jugular vein puncture group (n=138) according to different surgical methods, and the latter was divided into ultrasound guided puncture group (n=95) and blind puncture group (n=43). No puncture complications occurred in the external jugular vein incision group, and the average time for successful catheterization and the number of times for catheter to enter the superior vena cava were more than those in the internal jugular vein puncture group [(9.26±1.85) min vs. (5.76±1.56) min, (1.93±0.87) times vs. 1 time], with statistical significance. The average time of successful catheterization, the success rate of one puncture, the average number of punctures and the incidence of puncture complications in the ultrasound guided right internal jugular vein puncture group were better than those in the blind puncture group [(5.36±1.12) min vs. (6.67±1.99) min, 93.68% (89/95) vs. 74.42% (32/43), (1.06±0.24) times vs. (1.29±0.55) times, 2.11% (2/95) vs. 11.63% (5/43)], with statistically significant differences. The total incidence of complications in this study was 12.12% (20/165). Pneumothorax occurred in 1 case, artery puncture by mistake in 1 case, local hematoma in 5 cases, venous access port related infection in 4 cases (venous access port local infection in 2 cases, catheter related blood flow infection in 2 cases), subcutaneous tissue thinning on the surface of port seat in 2 cases, port seat overturning in 1 case, poor transfusion in 4 cases (catheter discount in 1 case, catheter blockage in 3 cases), and foreign bodies gathered around the subcutaneous pipeline in 2 cases. There were no complications, such as catheter rupture, detachment and catheter clamping syndrome. Conclusion: Totally implantable venous access port can provide safe and effective infusion channels for children with malignant tumors. Right external jugular vein incision and ultrasound-guided right internal jugular vein puncture are reliable surgical methods for children's totally implantable venous access port implantation. Surgeons should fully understand the complications of the venous access port, take measures to reduce the occurrence of complications, and properly handle the complications that have occurred.

Key words: Totally implantable venous access port, Catheterization, Postoperative complications, Child

中图分类号:

R726

李辉,高阳旭,王书磊,姚红新. 恶性肿瘤患儿完全植入式静脉输液港手术并发症[J]. 北京大学学报（医学版）, 2022, 54(6): 1167-1171.

Hui LI,Yang-xu GAO,Shu-lei WANG,Hong-xin YAO. Surgical complications of totally implantable venous access port in children with malignant tumors[J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1167-1171.

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Related indexes of catheterization	External jugular vein incision group (n=27)	Internal jugular vein puncture group (n=138)	χ²/t	P
Successful catheterization time/min, ${\bar x}$±s	9.26±1.85	5.76±1.56	10.820	0.012
Number of catheter placement, ${\bar x}$±s	1.93±0.87	1	240.382	< 0.001
Catheterization success rate/%	100.00	99.28	0.197	0.657

Related indexes of catheterization	Blind internal jugular vein puncture group (n=43)	Ultrasound-guided internal jugular vein puncture group (n=95)	χ²/t	P
Successful catheterization time/min, ${\bar x}$±s	6.67±1.99	5.36±1.12	12.491	0.001
Catheterization success rate/%	97.67 (42/43)	100.00	2.225	0.136
One-time puncture success rate/%	74.42 (32/43)	93.68 (89/95)	10.172	0.001
Number of puncture, ${\bar x}$±s	1.29±0.55	1.06±0.24	44.398	< 0.001
Puncture complication rate/%	11.63 (5/43)	2.11 (2/95)	5.390	0.020